How does this medication work? What will it do for me?

Topotecan belongs to the group of cancer-fighting medications known as antineoplastics. It kills cancer cells by interfering with the genetic material DNA, which is necessary for their growth and reproduction. Topotecan is used to treat a certain type of cancer of the ovary and a particular type of lung cancer.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are receiving this medication, speak to your doctor.

What form(s) does this medication come in?

Each single dose vial of a sterile lyophilized, buffered, light-yellow-to-greenish powder contains topotecan HCl equivalent to 4 mg of topotecan as free base. Nonmedicinal ingredients: mannitol and tartaric acid. Hydrochloric acid and sodium hydroxide may be used to adjust to a pH of 3. The solution pH ranges from 2.5 to 3.5.

How should I use this medication?

The recommended dose and dosing schedule of topotecan varies according to body size and the results of blood tests carried out before your treatment. It is injected into a vein through a specially prepared site on your skin. The appropriate dose is usually injected over 30 minutes, once daily for 5 consecutive days followed by 16 days without medication. This cycle is then repeated at least 3 more times.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. Your doctor may choose a schedule different from the one listed here.

Very careful handling of this medication is required. It is always given under the supervision of a doctor in a hospital or similar setting with access to sterile equipment for preparation.

As well as interfering with the genetic material DNA of cancer cells, topotecan can interfere with some of your normal cells. This can cause a number of side effects such as hair loss and mouth sores. Topotecan often causes nausea and vomiting, but you will be given medications to help control this. Your doctor, nurse, or pharmacist can advise you on how to reduce the effects of nausea and vomiting. Keep track of any side effects and report them to your doctor as suggested in the section, "What side effects are possible with this medication?"

It is important this medication be given exactly as recommended by your doctor. If you miss an appointment to receive topotecan, contact your doctor as soon as possible to reschedule your appointment.

This medication is stored at room temperature and protected from light.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Topotecan should not be used by anyone who:

is allergic to topotecan or to any of the ingredients of the medication

is breast-feeding

is pregnant

has severe depletion of neutrophils (white blood cells) or platelets

has severely reduced kidney function

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is used in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people receiving this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

appetite loss

burning or tingling in the hands or feet

constipation

diarrhea

fatigue

headache

nausea and vomiting

pain

redness or bruising at site of the injection

temporary hair loss

weakness

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

abdominal or stomach pain

sores or white spots on the lips, tongue, or inside the mouth

unusual fatigue or weakness

Stop taking the medication and seek immediate medical attention if any of the following occur:

black or tarry stools or blood in urine

cough or hoarseness with fever or chills

fever or chills

irregular or fast breathing

large welts on the face, eyelids, mouth, lips, or tongue

lower back or side pain with fever or chills

painful or difficult urination with fever or chills

pinpoint red spots on skin

puffiness or swelling of the eyelids or around the eyes

shortness of breath

skin rash, hives, or itching

unusual bleeding or bruising

wheezing or tightness in chest

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are receiving this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Blood clotting: This medication can reduce the number of platelet cells in the blood. Platelets help the blood to clot, and a shortage could make you bleed more easily. Tell your doctor of any signs that your blood is not clotting as quickly. Such symptoms may include black and tarry stools, blood in the urine, easy bruising, or cuts that won't stop bleeding.

Extravasation: This medication may be irritating to your veins while it is being administered. Please let your nurse know immediately if you feel any burning or pain at the injection site while the medication is being given.

Infection: As well as killing cancer cells, this medication can reduce the number of cells that fight infection in the body (white blood cells). Avoid contact with people who have contagious infections and tell your doctor if you begin to notice signs of an infection, such as fever or chills.

Lung inflammation: This medication can cause lung inflammation, especially for people with a history of lung problems (e.g., fibrosis, lung cancer, chest radiation). If you experience cough, fever, or shortness of breath, contact your doctor immediately.

Neutropenic colitis: This medication can cause neutropenic colitits, which is an inflammation of the colon associated with a decrease in white blood cells. If you experience abdominal pain with fever, seek immediate medical attention.

Weakness/tiredness: This medication is not expected to make you drowsy and impair your ability to drive or use machinery. However, it may make some people feel weak or tired. Do not drive or use machinery if you feel weak or tired.

Pregnancy: There is a possibility of birth defects with topotecan if it is taken during pregnancy. Effective birth control should be practiced while using this medication. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: It is not known if topotecan passes into breast milk. Women who are receiving this medication should not breast-feed.

Children: The safety and effectiveness of using this medication have not been established for children.

What other drugs could interact with this medication?

There may be an interaction between topotecan and any of the following:

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

stop taking one of the medications,

change one of the medications to another,

change how you are taking one or both of the medications, or

leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.